Abnormal Vaginal Discharge (AVD)

Clinical Description

• Causes: Vaginal infection, cervical infection, endometrial infection/pelvic inflammatory disease (PID)
• Common causes of vaginal infections: Trichomonas vaginalis, candida albicans and bacterial vaginosis.
• Common Causes of cervical infections: Neisseria gonorrhoeae and chlamydia trachomatis.

Note: Vaginal discharge is normal during and after sexual activity; at various points through- out the menstrual period; and during pregnancy and lactation.

Note: it is mandatory to perform a pelvic examination which includes a speculum examination for all women presenting with abnormal vaginal discharge.

Treatment

• Do risk assessment to identify women at risk of cervical infection
• Treat all women with vaginal discharge and a positive risk assessment for gonococcus and Chlamydia infection, plus trichomoniasis and
• If the discharge is white and curd-like also treat for candidiasis.
• Treat all women with vaginal discharge and a negative risk assessment for trichomoniasis and bacterial vaginosis
• If the discharge is white and curd-like, also treat for candidiasis.

Treatment

If vaginal discharge is present and the risk assessment is positive:

• Give Gentamycin 240mg IM stat plus
• Give Doxycycline 100mg 12 hourly for 7 days, plus
• Give Metronidazole 2g orally single dose

If the discharge is white or curd-like add 1 Clotrimazole pessary 500mg inserted intra- vaginally stat

If vaginal discharge is present and risk assessment is negative: Give Metronidazole 2g orally single dose stat ONLY

If the discharge is white or curd-like add 1 Clotrimazole pessary 500mg inserted intra- vaginally stat

If no discharge is found and risk assessment is positive:

• Give Gentamycin 240mg IM stat plus
• Give Doxycycline 100mg 12 hourly for 7 days

If no discharge is found and risk assessment is negative:

• Reassure client, counsel, educate and provide condoms.
• Advise client to come back if symptoms persist.
• Offer HIV testing after providing information and counselling
• Offer cervical cancer screening

Note: Examination of GUS in women should never be omitted only for convenience of the health worker.